Become a Member

New Membership Application

The application is two simple steps:

Application Information

Membership Dues Payment

To start enjoying the benefits of AMA membership, please fill out the registration form below. Make sure to fill out all blanks and to check your entries for typos. When finished, hit the submit button at the bottom of the page and you will be transferred to the payment page.

First Name*

Middle Name

Last Name*

Username*

Password*

Repeat Password*

E-mail*

Website

Gender*

Male

Female

Date of Birth*

Contact Info

Home Phone*Required phone number format: (###) ###-####

Mailing Address*

City*

State

Zip

Biographical Info

About Yourself

Practice Name*

Office PhoneRequired phone number format: (###) ###-####

Office Address

City

State

Zip

Professional Degree

M.D

Other (specify below)

Experience

Number of Years in Medical Practice

Primary Medical Specialty

Board Certified

Yes

No

Medical School Attended

Year Degree Conferred

Graduate School

Class Of

GA State Association Member

Yes

No

NMA Member

Yes

No

Professional Activity

Other

Special Category (check if applicable)

Active Duty Military

Resident/Fellow

Medical Student

Physician Member of a Chartered Medical Society in Non-US Country

Non-Physician Doctoral Level Medical School Faculty

International Involvement (Specify Below)

Primary AMA Medical Selection*

AMA Experts and Speakers' Bureau

The AMA Talent Bank includes medical experts who may be called upon to represent AMA to the media, as speakers, and on advisory panels. Do you consider yourself an expert in a particular sub-specialty or have an interest in participating on our speakers bureau?